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Universal Trip/Activity/Event Liability Waiver

Agreement to Participate, Including Assumption of Risks and Agreements of Release and Indemnity

Universal Trip/Activity/Event Liability Waiver

Agreement to Participate, Including Assumption of Risks and Agreements of Release and Indemnity

I understand and acknowledge that I have voluntarily agreed to participate in the trip/activity/event with the knowledge and understanding of the numerous risks and dangers involved, both known and unknown, including, but not limited to: exposure to the natural elements, which may include heat, extreme cold and high altitude, snow, sleet and rain; close personal contact, including the possibility of unwelcome touching, and dependence on other participants and staff; injury from (a) dangerous activities and/or contact with animals, (ii)  carelessness of other participants and staff, or (iii) failure of equipment and/or structures. I also understand that incidents may occur in remote places which may be many hours from medical facilities. These risks and hazards are inherent in the trip/activity/event; I understand and acknowledge that the above list is not complete or exhaustive and that other hazards and risks, known and unknown, may result in loss or damage to personal property, emotional and other personal injuries, including falls, abrasions, sprains, breaks, permanent disabilities and, in extreme cases, even death.

I represent that I have no medical or emotional condition which may adversely affect my participation in this trip/event and its associated activities, or which may cause me to be a danger to myself or others. I understand that it is my responsibility, and mine only, to determine my suitability, medical and otherwise, for participation in the trip/event and its associated activities.

ACKNOWLEDGEMENT AND ASSUMPTION OF ALL RISKS
I acknowledge, and assume all risks of participation in the trip/event, its activities and the environment in which it is conducted, whether or not these risks are inherent, and whether or not they are described above. I understand that in order to participate in the trip/activity/event, I must, and I hereby do, give up and irrevocably waive any and all rights I have or may ever have to hold Headwaters Ecology and Community Centers and any of their owners, agents, employees, officers and directors liable for any injury or damage which I may suffer. I ASSUME THE RISK OF ALL LOSS, DAMAGE, INJURY, OR DEATH suffered which may in any way arise from or be associated with participation in any exercise or activity, or the use of the equipment and facilities of Headwaters Ecology and Community Centers.

Without limiting the foregoing, I specifically acknowledge the risks associated with biking, cooking, yoga, or any other activities as well as the use of property, facilities, the unpredictability of animals and the risk of being near others that have firearms in their possession.

AGREEMENTS OF RELEASE AND INDEMNITY
I HEREBY WAIVE, RELEASE FROM LIABILITY, AND COVENANT NOT TO SUE HEADWATERS ECOLOGY AND COMMUNITY CENTERS OR THEIR OWNERS, AGENTS, EMPLOYEES, MANAGERS, OFFICERS AND DIRECTORS AND AFFILIATES FOR OR WITH RESPECT TO ANY AND ALL LIABILITY RESULTING FROM OR ARISING OUT OF PARTICIPATION IN THE ACTIVITIES OF THE TRIP/EVENT AND/OR ACTIVITIES DESIGNATED ABOVE.  This waiver, release and covenant not to sue extends to any and all claims, demands, complaints, causes of action, costs or expenses (including attorney's fees), which I may have now or hereafter acquire, known or unknown, contingent or liquidated, of any nature whatsoever, including negligence, arising from or which in the future may arise from, any of the causes noted and/or any act or omission of any individual, whether agent, owner, manager or employee of Headwaters Ecology and Community Centers, a third party, an independent contractor or another guest at the facility.  This waiver, release from liability and covenant not to sue shall be binding on me, and upon my heirs, personal representatives and all other successors in interest.  It is intended that this waiver, release and covenant not to sue be interpreted as broadly and inclusively in scope as permitted by the laws of the State of Colorado, including C.R.S. 13-22-107.

Any and all disputes, claims, actions, causes of action or controversies of any kind or nature whatsoever arising out of or in connection with the trip/event or activity designated above including but not limited to any alleged negligence, tort, breach of contract, waiver, intentional conduct, medical care or treatment shall be resolved by arbitration with the American Arbitration Association, in Grand County, Colorado, pursuant to the Commercial Arbitration Rules of the American Arbitration Association.  This agreement to arbitrate shall be specifically enforceable under the laws of the State of Colorado. Any lawsuit to enforce an arbitration shall be instituted solely in the State of Colorado, and this waiver and agreement shall be governed by Colorado law.

I HEREBY ACCEPT FULL LEGAL RESPONSIBILITY and shall defend, hold harmless and indemnify Headwaters Ecology and Community Centers, and their owners, employees, agents, managers, officers and directors and affiliates from any and all liabilities, damages to property or injuries sustained as a result of my participation in the trip/activity/event designated above.

OTHER
I authorize Headwaters Ecology and Community Centers to provide or obtain medical care for me in the event of an incident requiring medical attention, and I further authorize Headwaters Ecology and Community Centers to exchange with any third-party medical care giver such information regarding my medical history or condition as may be deemed important to either of them.

I understand that the trip/activity/event and all aspects of it are purely voluntary and I may choose not to participate. I agree that I will follow all safety instructions. I further agree to allow Headwaters Ecology and Community Centers to use photographic or other images of me for marketing or any other purpose deemed reasonable by Headwaters Ecology and Community Centers.

I have carefully read this form, fully understand its contents, and sign it of my own free will.  I verify that I have fully completed this form and that I have authority to enter into this form agreement. Should any part of this agreement be deemed not enforceable by a Court of competent authority, the remainder of the agreement shall nevertheless remain in full force and effect.


Dated: July 25, 2021

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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